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Nurses Rap Payment Models Recommended by AMA

John Commins, for HealthLeaders Media, November 20, 2013

The AMA recommendations call for:

  • Physicians who lead team-based care in their practices to receive payments for healthcare services provided by the team and to establish payment disbursement mechanisms that foster physician-led team-based care; 
  • Physicians to make decisions about payment disbursement in consideration of team member contributions, including factors such as volume and intensity of the care provided, the profession, training and experience of each team member and the quality of care provided; 
  • Payment systems for physician-led team-based care: to reflect the value provided by the team, with the savings accrued by this value shared by the team; to reflect the time, effort, intellectual capital provided by individual team members; to be adequate to attract team members with the appropriate skills and training to maximize the success of the team; and, to be sufficient to sustain the team over the time frame that is needed.

Not surprisingly, nurses associations are not embracing a list of recommendations that leaves physicians calling all the shots.

"We have supported integrated models of care moving towards reimbursement alignment for quality and outcomes over fee-for-service," says Tay Kopanos, DNP, FNP, vice president of state government affairs for the American Association of Nurse Practitioners.

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6 comments on "Nurses Rap Payment Models Recommended by AMA"


Jon Burroughs (11/24/2013 at 9:06 PM)
It is not either/or, it is and. In New Hampshire, nurse practitioners can work independently of physicians but choose to work collaboratively with them due to their interdependent skills and areas of expertise. One is not better than another; each brings different skills and perspectives that are equally valuable to the patient.

Brad Thornton (11/22/2013 at 8:23 AM)
Speaking as a long time nurse and less time Administrator I see mid-level and MD performance comparisons all day long. There is a constant and predictable difference in outcomes and costs in favor of the MD. However, this "clinical" competence does NOT make them a strong leader, nor does it make them effective in their management of staff or mid-levels. My experience says we need some degree of mid-level oversight but, of equal importance in the process, physicians must learn leadership and management skills....bt

Jeff angel (11/22/2013 at 4:22 AM)
Let me sum up a physician versus mid-level: depth and breadth of training, not to mention rigors of training that weed out the lazy and the ones who cannot think when tired, etc I see unnecessary tests and wrong treatment plans by midlevels nearly everyday. Like it or not, there is a big difference in training. Studies have shown midlevels order more tests/have higher costs. There is nothing wrong with supervision and collaboration. Its better care and nothing but jealousy to not want help!! Lets work together...with appropriate supervision by leaders who have more training.